ObGyn Intelligence — Postpartum

Postpartum Contraception Guide

Evidence-based contraceptive method selection for the postpartum period, using CDC Medical Eligibility Criteria (US MEC 2024). Personalized by breastfeeding status, delivery timing, and medical history.

Evidence Base

Curtis KM, Tepper NK, Jatlaoui TC, et al. U.S. Medical Eligibility Criteria for Contraceptive Use, 2016. MMWR Recomm Rep. 2016;65(3):1–103. — Primary source for all MEC categories and postpartum timing recommendations.
American College of Obstetricians and Gynecologists. Immediate Postpartum Long-Acting Reversible Contraception. ACOG Committee Opinion No. 788. Obstet Gynecol. 2019;133(4):e208–e216. — ACOG endorsement of immediate postpartum LARC placement.
American College of Obstetricians and Gynecologists. Postpartum Contraceptive Access. ACOG Committee Opinion No. 736. Obstet Gynecol. 2018;131(5):e130–e139. — Access and counseling framework for postpartum contraception.
Tepper NK, Phillips SJ, Kapp N, et al. Combined hormonal contraceptive use among breastfeeding women: an updated systematic review. Contraception. 2016;94(3):262–274. — Evidence base for CHC timing and breastfeeding safety.

Time Since Delivery

Contraceptive eligibility changes significantly in the first 6 weeks postpartum due to VTE risk, breastfeeding establishment, and uterine involution.

Immediately postpartum — within 48 hours of delivery

Hospital-based contraception; LARC placement highly effective at this time

Less than 21 days postpartum

Highest VTE risk period — combined hormonal contraceptives generally avoided

21 to 42 days postpartum

Transitional period; CHC eligibility depends on VTE risk factors and breastfeeding

Breastfeeding Status

Estrogen-containing methods (combined hormonal contraceptives) may suppress milk supply, particularly in the first 6 months. Progestin-only methods do not appear to affect lactation.

Exclusively or predominantly breastfeeding

No formula supplementation; baby is under 6 months old

Partially breastfeeding or breastfeeding infant older than 6 months

Not breastfeeding

Medical History

Select any conditions that apply. These affect eligibility for specific contraceptive methods per CDC MEC.

Prior VTE (DVT or pulmonary embolism), or known thrombophilia

VTE risk factors: immobility, obesity (BMI ≥30), postoperative recovery, heavy blood loss

Hypertension — systolic ≥140 or diastolic ≥90 mmHg

Migraine with aura

Active liver disease or known liver tumor

Peripartum cardiomyopathy

Significant postpartum hemorrhage (>1,000 mL blood loss)

None of the above — no significant medical history